This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 3 March 2009

A Dignified Revolution: WHAT. THE. HELL?

I trained at a top school to earn my nursing qualifications. It was very academic but also very hands on.

We were taught that it is 100% the job of the registered nurse to provide hands on basic care.

We were taught that we should push hospitals to do away with most ancillary staff and that a patient is only safe with a registered nurse providing all of his total care. This can only happen if each nurse has a smaller number of patients. Our instructors were well educated and old fashioned. They foresaw the trend of more ancillary staff than registered nurses being used to staff a ward.

We were also taught that if we so much as miss a deteriorating patient, or infuse a drug late resulting in harm to a patient because we were giving out commodes ...then we would be facing serious legal action. It is a fact.

So what the hell happened? Why are patients starving to death in their own waste? We all know it is happening.

Hospital management has deliberately short staffed the wards in favour of trying to make a profit. On general wards, where patients are the most vulnerable, the nurses are overloaded with way to many patients. Providing basic care becomes so dangerous. The nurses are forced to make tough decisions about who gets care. The wrong decision could mean permanent harm, death, lawsuits and banishment from the nursing profession.

I am so alone. I am overwhelmed. I only have care assistants to help, and all they can do is basic care. I want to through all the other stuff at THEM and have a pleasant day bed bathing and feeding patients.

I have been a qualified nurse for 12 years. I know nurses. I know degree educated nurses and old fashioned nurses. The vast majority enjoy providing basic and feel that it is the best way to assess a patient properly and head off problems. THE VAST MAJORITY FEEL THIS WAY. The other .02% who don't feel this way are just nasty. Give me a baseball bat and some tar and feathers and I'll sort those few out myself. Throw the managers and the modern matrons in with them and I might sort several problems out with one swing of my trusty bat.

Look at what this silly nurse did. Silly right? What they hell are they teaching them up in Yorkshire?

She was an idiot. It is easy to see that she screwed up. But she was also under insane pressure. If I immediately stopped to fetch a commode every time someone asked for one, I would be in silly nurse's shoes. Every minute of every shift their are multiple people begging for the commode and multiple people deteriorating before my eyes. I have to make a choice. It sucks. If I get lucky and get a shift with stable patients and more nurses ......... my patients get great care including their basic needs met. It happens once in a blue moon that I get that kind of shift. That is my version of "getting lucky".

If she had ignored the commodes they would have complained about her and slammed her. If she had sent the care assistant to get the commode and went to the unwell patient then they would say that she is "too posh to wash". If she had left her patient on the commode to attend to the dying man and that patient fell of the commode because she left him unattended she would also have been struck off.

All you have to do is go to any of Britain's newspapers online. Type in "Nurses" and "too Posh to Wash". Look at the articles. I did a take on a few of these articles earlier in my blog:

You will be bombarded with comments from the public stating that any nurse who doesn't immediately stop to hand out a commode when asked "doesn't want to be bothered" and "should be struck off". No one asks how many other patients she has and what is going on with them. If I did nothing but commodes all day and ignored every single other thing I STILL wouldn't get around to all my patients in a timely fashion.

What the fuck is wrong with the public? Why are they not concerned about what is really happening on these wards?

I want to see patients get dignified, excellent treatment no matter how old or infirm they might be. I want to provide all of their nursing care and do a great job and be super nurse. My colleagues are the same. We all want to be the nurse with the most thank you cards on the staff room wall. We all have elderly and ill loved ones who are in and out of hospital. We know....

But how these people are going about achieving their goals and how they are trying to "inform the public" is atrocious. Have a look at that link.

I accept that there are bad nurses. I have worked with nurses who were as ugly on the inside as they were on the outside (which is saying A LOT). They are not the majority. I have worked with 3 nurses who "don't care" out of the hundreds of nurses I have worked with in hospitals over more than a decade. I have met about 5 HCA's who were pure evil. This is out of hundreds that I know. No amount of dignity training will sort people like this out. They need to be fired. Give control back to the ward staff. We will sort them out.

But nothing will be achieved if we cannot do our jobs. Good nurses will continue to fail on an under resourced short staffed ward. If that is the case, how can we possibly sort out the few and far between bad ones?

15 comments:

I agree with Angus, the public believe the media, after all "They would not print it, show it on television, talk about it on radio, (pick any one) if it was not true." I remember one piece of investigative journalistic crap which was shown on television about 2-3 years ago which showed a nurse on her break in the staff room being asked by a supposedly experienced HCA to help reattach a urine bag which had come loose. This HCA who was working undercover and wearing a secret camera, then showed how the nurse dared to finish her break before coming out. Heavily edited to make the nurses look lazy and uncaring and the HCA look as if she was doing all the work. Who took the flak for that? The nursing staff - how dare you eat or drink anything when people are lying in p*ss etc. never mind thata) she was entitled to a break, b) the HCA should have been able to reattach a urine bag, c) the ward was understaffed for the workload, d) the person who was commenting on this film was a psychiatric nurse who had not been on a general ward for years and e) the RCN an NMC did it's usual let's side with management crap

Surely, the problem is that for the majority of the public their only source of information is the media. It would appear that the media do not broadcast the full story; we do not appear to have investigative journalists any more nor even purveyors of objective articles. To discover the other side of the story one has to seek out blogs like this one. The problem with using blogs is that one tends to seek out ones that relate to the subject matter that one is interested in and, having found them, read only those that agree with the sentiments that one already has. In general people do not have the time to seek out blogs so they resort to relying on the media. Until we can do something about that then people will continue to appear uninterested.

"That was probably the first time that nurse sat down in 12 hours. There will never be a time in a shift when you can eat without leaving someone in a less than desirable way."

On a recent nightshift, started at 9pm (A&E)..had an awful night, constant, no let-up, or break. Got first sitdown and full cup of warm tea at 6.50am (at the nurse base)It was bliss...sittin, bum on chair...warm tea, after 10hours on the go solid.. (actually nothing to do at that point either, which is why we sat down) OH MY GOD. You should have seen the dirty looks from relatives behind the curtain. We could see it in their eyes...lazy nurses...look at them...just sat there...

Well, yes, after 10 hours of running around like HELL...it WILL take more than a leaky catheter to get me up off my chair and leave my warm tea!! I'm not a bloody athelete, super-human, no-need-to-eat-or-drink-robot-machine! I'm not immune from collapse you know!

Very interesting what you say, I hear a lot of fundations that help people on street, etc etc there's always money in the middle that's why it's very difficult to belive in people like that, I remember once a guy on the street ask me for some money and I didn't have money on the moment but I gave him my sandwhich and the guy took it and throw it on the trash... in many ways nobody appreciate what you do.Good luck

This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. camiseta de futbol replicas The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards. "The martyr sacrifices themselves entirely in vain.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.